John Aravosis of AmericaBLOG has what strikes me as one of the encapsulations of the health care reality that I’ve read. Aravosis writes:

Our health care system is being run by thieves. These people don’t care if you stay healthy or get better, they’re the nasty chairman of the board on House a few seasons back who was simply interested in making money, nothing more.

Democrats need to keep reminding themselves that the problem isn’t just costs. The problem isn’t just the uninsured. The problem is that all of us are bought into a system that doesn’t work. And even those of us who make a good salary for a living (well, in other years) will be in serious trouble if we ever come down with any serious illness that requires $2000 a month in prescriptions (such as MS or HIV).

We need a fix that doesn’t just add more people into a bad system. We need more people in a better system. And the better system needs to benefit everyone, not just the poor, not just the middle class.

This really resonates with my views on health care and the need for reform. It’s not just about covering more people, but giving all Americans coverage that works, that meshes with the reality of treating acute illnesses or chronic diseases. Unless and until we can have a health care system that addresses Aravosis raises in this passage, we will not have an adequate health care system in America. What’s unfortunate is that the volume of opposition to any reform is so strong that anything is likely to win out over the right things when it comes to what is actually done.

The metric for success that the administration and stakeholders should be using when assessing the adequacy of any reforms that are considered should not be how many more people get coverage who don’t currently have it, but if we’ll need to pass another round of reform in the foreseeable future to fix what was not achieved in this round of legislation.

Paul Krugman’s take on the health care industry’s (aka “medical-industrial complex”) announcement that they will find ways to cut $2 trillion from their costs over the next 10 years is informative. Krugman is, in my view, the best liberal bellwether at assessing the administration’s economic and health care policy decisions. While Krugman identifies a number of area of concerns in the announcement from the medical-industrail complex, he’s overall positive and optimistic. When Krugman says the announcement is “some of the best policy news I’ve heard in a long time,” it’s certainly heartening.

What concerns me is what the medical-industrial complex believes these concessions will enable them to push for with the administration. Do they expect the media and the administration to believe this move has necessitated they get a seat at the bargaining table? Will they use the good will they’ve earned to fight against a public health care option in the reform package? Would they embrace any form oversight into whether or not they’re succeeding in cutting their promised 1.5% over the next 10 years? While this isn’t something the administration is saying they’ll do, you have to imagine that at some point a voluntary course of action will not be sufficient to ensure the kinds of cost controls necessary to allow adequate reduction in delivery costs for true health care reform.

I’m not a health care policy expert, but I hope that Krugman’s analysis holds. From a political standpoint – and a long-term policy standpoint – it worries me that any concession from the medical-industrial complex will be met by an imperative for Democrats and reformers to diminish the scope of their goals for change.

Update:

Jonathan Cohn of TNR, who is probably the most knowledgeable liberal health care reporter, has a similar take to Krugman.

I like where Jonathan Gruber is going with this, but don’t think he’s going far enough.

Given the present need to address the economic crisis, many people say the government cannot afford a big investment in health care, that these plans are going nowhere fast. But this represents a false choice, because health care reform is good for our economy.

As the country slips into what is possibly the worst downturn since the Depression, nearly all experts agree that Washington should stimulate demand with new spending. And one of the most effective ways to spend would be to give states money to enroll more people in Medicaid and the State Children’s Health Insurance Plan. This would free up state money for rebuilding roads and bridges and other public works projects — spending that could create jobs.

Health care reform can be an engine of job growth in other ways, too. Most proposals call for investments in health information technology, including the computerization of patient medical records. During the campaign, for example, Mr. Obama proposed spending $50 billion on such technology. The hope is that computerized recordkeeping, and the improved sharing of information among doctors that it would enable, would improve the quality of patient care and perhaps also lower medical costs. More immediately, it would create jobs in the technology sector. After all, somebody would need to develop the computer systems and operate them for thousands of American health care providers.

Gruber’s thinking about this in terms of how to direct a part of a stimulus package that will likely run around $500 billion. I agree that health care should be a part of that, but when its relegated to the realm of pie-yet-to-be-divvied-up, it’s hard to envision enough being done to make both the necessary economic difference and substantively make peoples’ lives better. What I want to see is unabashed argumentation that goes along the lines of this: Companies like GM, Citigroup, and AIG exist with the presumption that they must continue to exist, regardless of how poorly they have been run. The response to the economic crisis has run over $7 trillion. There is no reason that these large, poorly managed corporations are more entitled to health and prosperity than the citizens of the United States. Don’t just ask for expanding state children’s health care programs — go whole hog. Now is the time for health care for all, paid for by the US government. Gruber lays out the economic benefits of health care spendingas a response to economic troubles. But just as the bailouts are stop-gap, single-payer health care is long-term. Businesses can’t plan on the next government bailout (well, maybe Citigroup was), but they can plan on the reduction of their costs by 15-20% permanently by not having to pay for their employees and retirees health care.

The Wall Street crowd in New York and the shock doctrine crowd in DC get the fact that now is the time to go big. It’s time for those of us who are working for all Americans to do the same.

Yesterday I took a shot at Rep. Steve Kagen for voting “present” on a resolution praising the New York Giants for their Super Bowl win. Today I wanted to draw attention to a column Kagen has in the Huffington Post on legislation he’s introduced to end discriminatory practices in the health care industry. Here’s an excerpt:

I’ve introduced the No Discrimination in Health Insurance Act. This essential legislation will guarantee access to affordable care for every citizen in America by bringing an end to discriminatory practices employed by insurance companies who deny life-saving coverage to millions of Americans solely because of their pre-existing medical conditions.

…

The reality is our nation’s insurance industry has been successful beyond all measure by dividing and conquering almost all Americans. They’ve divided neighbor from neighbor, and even mother from child, by insuring individuals instead of entire communities. We can begin to heal our nation by putting unity back into community ratings.

My no discrimination act requires companies to openly disclose their prices, and to charge every citizen the same fee for the same service within the region, allowing all citizens to finally benefit by paying the lowest fees available.

Ending discrimination in health insurance is the right thing to do, and it will reduce costs for everyone’s care. Simply put, if you’re a citizen, you’re in — with no discrimination against you due to pre-existing medical conditions.

I’m no expert on health care, so I look forward to seeing what more knowledgeable people have to say about Kagen’s legislation. But on its face, until we have universal health care, steps like this to end discriminatory practices by the insurance industry are necessary.

It strikes me as much easier to scare people about government-run health care than it is to muster the leadership to get universal health care (or, in the current iteration of Democratic proposals, universal access to affordable health care coverage) passed. As no one is actually proposing universal health care, I think the explanatory barrier to overcome fear mongering from any side is actually higher now than it would be with a simple Medicare-for-All proposal. Fear mongering is going to be more effective when the plans being proposed are complex and complicated.